In Medicaid talks, sidelong glances at other states

What is Arkansas doing? What is Iowa doing? In Pennsylvania, such questions are the stuff of meetings among staffers of the Department of Public Welfare tasked with working on a possible Medicaid expansion plan. The goal: a tailor-made plan that suits Gov. Corbett and key Republican constituencies.

An expansion, authorized by the federal Affordable Care Act, would make hundreds of thousands of additional low-income Pennsylvanians eligible for Medicaid. Corbett's stance on the issue has been unchanging, but ever poised to change - he has said, repeatedly, that he cannot accept an expansion without certain reforms. An oft-cited requirement is that low-income children enrolled in Pennsylvania's health care insurance program be allowed to stay there, not be switched to Medicaid.

In the meantime, Public Welfare Secretary Bev Mackereth said her team has been implementing what she calls "phase one" of the ACA - the mandatory health care exchange that should be open in Pennsylvania in October (the marketplace is federally required to be functional in January 2014).

"It's been all hands on deck," Mackereth told the York Rotary Club Wednesday at the group's weekly meeting.

As for phase two? Talks continue between state and federal officials. They're not yet negotiations, Mackereth said: "We have not presented them with a plan." She said the state is still gauging federal support for a variety of reforms the Corbett administration would want, and looking at other state-specific proposals to which federal officials have warmed.

"What did they agree to for this state, what did they agree to for this state?" said Mackereth. She mentioned a public-private partnership idea applied in Arkansas' proposal. "We don't look at all like Arkansas, so you know," Mackereth cautioned. The plan would send would-be Medicaid enrollees to buy health care insurance from the state's exchange and pay for the plans with public dollars.

A similar plan has been floated in Iowa. "Iowa just put theirs in," Mackereth said.

Other potential pieces of an expansion plan, she said, require more negotiation.

"The governor feels very strongly about a work-search requirement, and the feds initially said, 'Absolutely no way," said Mackereth. "They're still saying 'no way,' but now they're saying, 'You know what, if you build it into what you do every day, and if work search is part of everything, that's different.'"

Politically speaking, the search for reforms is important. The state Legislature would need to sign off on a Medicaid expansion plan. It has majority support in the Senate, as well as the favor of House Democrats. But it doesn't stand a strong chance of coming to a vote in the House unless Republican lawmakers there feel satisfied they've seen sufficient reforms.

Mackereth said there is "no deadline" for hammering out a deal on a possible Medicaid expansion. She sticks to a timetable she mentioned in May - that the earliest any such increase in enrollment could be implemented would be in 2015.